Therapeutic responses of psychopathic sexual offenders: Treatment attrition, therapeutic change, and long-term recidivism.

The authors examined the therapeutic responses of psychopathic sex offenders (≥25 Psychopathy Checklist—Revised; PCL–R) in terms of treatment dropout and therapeutic change, as well as sexual and violent recidivism over a 10-year follow-up among 156 federally incarcerated sex offenders treated in a high-intensity inpatient sex offender program. Psychopathy and sex offender risk/treatment change were assessed using the PCL–R and the Violence Risk Scale—Sexual Offender version (VRS–SO), respectively. Although psychopathic participants were more likely than their nonpsychopathic counterparts (     

Group treatment program for sexually and physically assaultive young offenders in a secure custody facility.

This paper describes a treatment program which provides group therapy to young male offenders (average age 17 yrs) convicted of sexual and physical assault. The traditional difficulty of providing group therapy to male adolescent sex offenders housed with non-sex offenders in secure custody facilities led to development of the program. In the group treatment therapy program, young offenders convicted of physical and sexual assaults may participate in a common group where they acquire awareness of maladaptive behaviors (i.e., inappropriate modes of relating to both women and men), empathy with victims, awareness of high risk situations, and enhancement of prosocial behaviors. The group treatment program is semi-structured and is based on cognitive, behavioral and social learning principles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A high risk recognition program for adolescents in conflict with the law.

Describes a high risk recognition program aimed at reducing recidivism among the heterogeneous young offender population. The program, which is based on cognitive-behavioral relapse prevention programs for adult sexual offenders, was developed for use within an inpatient treatment program for 14–18 yr olds sentenced to secure custody for a variety of crimes. Young offenders identify risk factors or warning signs for various forms of offending behavior based on their analysis of past criminal acts. They then generate strategies for coping with future recurrence of these risk factors. The authors consider the utility and applicability of such an intervention and make recommendations for researching the efficacy of the technique. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating adolescent sexual offenders.

A significant number of sexual offenses are committed by adolescents. This article addresses clinical and ethical issues to be considered by the clinician in assessing adolescent sexual offenders. Issues in the treatment of adolescent sex offenders are discussed. A treatment program based on a cognitive behavioral model is described and follow-up data are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of predictors of offender treatment attrition and its relationship to recidivism.

Objective: The failure of offenders to complete psychological treatment can pose significant concerns, including increased risk for recidivism. Although a large literature identifying predictors of offender treatment attrition has accumulated, there has yet to be a comprehensive quantitative review. Method: A meta-analysis of the offender treatment literature was conducted to identify predictors of offender treatment attrition and examine its relationship to recidivism. The review covered 114 studies representing 41,438 offenders. Sex offender and domestic violence programs were also examined separately given their large independent literatures. Results: The overall attrition rate was 27.1% across all programs (k = 96), 27.6% from sex offender programs (k = 34), and 37.8% from domestic violence programs (k = 35). Rates increased when preprogram attrition was considered. Significant predictors included demographic characteristics (e.g., age, rw = ?.10), criminal history and personality variables (e.g., prior offenses, rw = .14; antisocial personality, rw = .14), psychological concerns (e.g., intelligence, rw = ?.14), risk assessment measures (e.g., Statistical Information on Recidivism scale, rw =.18), and treatment-related attitudes and behaviors (e.g., motivation, rw = ?.13). Results indicated that treatment noncompleters were higher risk offenders and attrition from all programs significantly predicted several recidivism outcomes ranging from rw = .08 to .23. Conclusions: The clients who stand to benefit the most from treatment (i.e., high-risk, high-needs) are the least likely to complete it. Offender treatment attrition can be managed and clients can be retained through an awareness of, and attention to, key predictors of attrition and adherence to responsivity considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The discriminative validity of a phallometric test for pedophilic interests among adolescent sex offenders against children.

The authors examined the responses of adolescent sex offenders against children on a phallometric test of pedophilic interests. Participants were 40 adolescent sex offenders against children, 75 young adult sex offenders against children, and 39 young adult comparison participants. The responses of adolescents with female victims resembled those of comparison participants; adolescents with any male victims had larger relative responses to child stimuli than comparison participants. Young adult offenders, regardless of victim sex, had larger relative responses to child stimuli than comparison participants. Using a cut score of 0 (indicating equal or greater arousal to children than to adults), sensitivity was 42% for adolescents with any male victims, and specificity was 92% for the comparison participants. Results suggest phallometric testing can identify pedophilic interests among these adolescent sex offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The preliminary development of theory-based community treatment for sexual offenders.

A treatment program that is based on a theoretical model (Hall & Hirschman, 1991, 1992) was developed and implemented in community-based treatment programs with child molesters and rapists. Procedures that address physiological, cognitive, and affective motivational precursors of sexually aggressive behavior and relapse prevention are described. Seventeen of 24 of the participants who began treatment completed it. One of the 17 sexual offenders who completed treatment recidivated by violating probation, whereas 7 of the 13 sexual offenders who did not complete treatment recidivated. These results could simply be a function of participant motivation because participants were not randomly assigned to conditions. Nevertheless, the current program appears to be viable for research and clinical implementation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health-related quality of life measurement for evaluation research and policy analysis.

Describes a unit of health status, the "Well-Year," which expresses the output of health programs in terms of the number of years and the health-related quality of life produced by a treatment or program. Dividing the cost of the program by the number of Well-Years that it produces gives the cost–utility of the program. This cost–utility ratio can be used in a general health policy model to compare the efficiency of different programs or to assess the relative contribution of different programs and providers in the health-care system. Different components of the model are useful (1) for the effectiveness of medical interventions, (2) to assess the quality of care, (3) to improve clinical decision making, (4) to assess needs of different populations, and (5) to understand causes of variations in health. A comprehensive standardized measure of health status has many advantages for health planning, decision analysis, and program evaluation. An example demonstrates how the relative production of Well-Years by psychologists might be compared to the contribution of other health-care services. (66 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homicidal sex offenders: psychological, phallometric, and diagnostic features

Homicidal sex offenders represent an understudied population in the forensic literature. Forty-eight homicidal sex offenders assessed between 1982 and 1992 were studied in relation to a comparison group of incest offenders. Historical features, commonly used psychological inventories, criminal histories, phallometric assessments, and DSM diagnoses were collected on each group. The homicidal sex offenders, compared with the incest offenders, self-reported that they had more frequently been removed from their homes during childhood and had more violence and forensic psychiatric contact in their histories. On the self-report psychological inventories, the homicidal sex offenders portrayed themselves as functioning significantly better in the areas of sexuality (Derogatis Sexual Functioning Inventory) and aggression/hostility (Buss-Durkee Hostility Inventory). However, on the Psychopathy Checklist-Revised (PCL-R), researchers rated the homiciders significantly more psychopathic than the incest offenders on Factor 1 (personality traits) and Factor 2 (antisocial history). Police records revealed the homicidal subjects also had been charged or convicted of more violent and nonviolent nonsexual offenses. The phallometric assessments indicated that the homicidal sex offenders demonstrated higher levels of response to pedophilic stimuli and were significantly more aroused to stimuli depicting assaultive acts to children, relative to the incest offenders. Despite the homiciders' self-reports of fairly good psychological functioning, DSM-III diagnoses reliably discriminated between the groups. A large number of homicidal sex offenders were diagnosed as suffering from psychosis, antisocial personality disorder, paraphilias, sexual sadism, sexual sadism with pedophilia, and substance abuse. Seventy-five percent of the homicidal sex offenders had three or more diagnoses compared with six percent of the incest offenders. The article addresses the role of "hard" versus "soft" measures in the assessment and treatment of violent sex offenders. In addition, the usefulness of phallometric assessments and the PCL-R and its subscales are considered.     

Rehabilitating criminal justice policy and practice.

For over 30 years, criminal justice policy has been dominated by a “get tough” approach to offenders. Increasing punitive measures have failed to reduce criminal recidivism and instead have led to a rapidly growing correctional system that has strained government budgets. The inability of reliance on official punishment to deter crime is understandable within the context of the psychology of human conduct. However, this knowledge was largely ignored in the quest for harsher punishment. A better option for dealing with crime is to place greater effort on the rehabilitation of offenders. In particular, programs that adhere to the Risk-Need-Responsivity (RNR) model have been shown to reduce offender recidivism by up to 35%. The model describes: a) who should receive services (moderate and higher risk cases), b) the appropriate targets for rehabilitation services (criminogenic needs), and c) the powerful influence strategies for reducing criminal behavior (cognitive social learning). Although the RNR model is well known in the correctional field it is less well known, but equally relevant, for forensic, clinical, and counseling psychology. The paper summarizes the empirical base to RNR along with implications for research, policy, and practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The Characteristics of Persistent Sexual Offenders: A Meta-Analysis of Recidivism Studies.

A meta-analysis of 82 recidivism studies (1,620 findings from 29,450 sexual offenders) identified deviant sexual preferences and antisocial orientation as the major predictors of sexual recidivism for both adult and adolescent sexual offenders. Antisocial orientation was the major predictor of violent recidivism and general (any) recidivism. The review also identified some dynamic risk factors that have the potential of being useful treatment targets (e.g., sexual preoccupations, general self-regulation problems). Many of the variables commonly addressed in sex offender treatment programs (e.g., psychological distress, denial of sex crime, victim empathy, stated motivation for treatment) had little or no relationship with sexual or violent recidivism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency of MMPI two-point code types among sex offenders.

Two-point Minnesota Multiphasic Personality Inventory (MMPI) codes were calculated for 403 convicted sex offenders, yielding 43 code types. The relative frequencies of codes were compared among rapists, child molesters, incest offenders, first offenders, and recidivists. Code frequencies were also compared with frequencies in previously reported studies of psychiatric patients and criminals. Sex offenders showed more 4–5 and 4–8 profiles than other prisoner groups. Rapists showed more profiles that are usually associated with assaultiveness. There were significant differences in code frequencies between incestuous biological fathers and stepfathers and between first offenders and recidivists. The heterogeneity of MMPI profiles precludes stereotypic generalizations about sex-offender characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What is so special about male adolescent sexual offending? A review and test of explanations through meta-analysis.

We tested special and general explanations of male adolescent sexual offending by conducting a meta-analysis of 59 independent studies comparing male adolescent sex offenders (n = 3,855) with male adolescent non-sex offenders (n = 13,393) on theoretically derived variables reflecting general delinquency risk factors (antisocial tendencies), childhood abuse, exposure to violence, family problems, interpersonal problems, sexuality, psychopathology, and cognitive abilities. The results did not support the notion that adolescent sexual offending can be parsimoniously explained as a simple manifestation of general antisocial tendencies. Adolescent sex offenders had much less extensive criminal histories, fewer antisocial peers, and fewer substance use problems compared with non-sex offenders. Special explanations suggesting a role for sexual abuse history, exposure to sexual violence, other abuse or neglect, social isolation, early exposure to sex or pornography, atypical sexual interests, anxiety, and low self-esteem received support. Explanations focusing on attitudes and beliefs about women or sexual offending, family communication problems or poor parent–child attachment, exposure to nonsexual violence, social incompetence, conventional sexual experience, and low intelligence were not supported. Ranked by effect size, the largest group difference was obtained for atypical sexual interests, followed by sexual abuse history, and, in turn, criminal history, antisocial associations, and substance abuse. We discuss the implications of the findings for theory development, as well as for the assessment, treatment, and prevention of adolescent sexual offending. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical pharmacy services in hospitals educating pharmacy students

In 1995 we conducted a national survey of 1102 acute care hospitals in the United States to determine types of clinical pharmacy services, patient-focused care, and pharmaceutical care used to educate and train pharmacy students, and compared outcomes with surveys in 1989 and 1992. Clinical pharmacy services offered in 50% or more of Pharm.D.-affiliated hospitals (core services) were drug-use evaluation, in-service education, pharmacokinetic consultations, adverse drug reaction management, drug therapy monitoring, protocol management (most common for aminoglycosides, nutrition, antibiotics, heparin, warfarin, theophylline), nutrition team, and drug counseling. Comprehensive pharmaceutical care programs were established in 64%, 42%, and 33% of Pharm.D., B.S., and nonteaching hospitals, respectively. Patient-focused care programs were beginning or established in 77%, 71%, and 60%, respectively. Pharmacists served as care team leaders in 23% of hospitals affiliated with a college of pharmacy. Most common ambulatory care clinics were oncology, anticoagulation, diabetes, geriatrics, refill, and infectious diseases/HIV. For-profit hospitals rarely provided education for pharmacy students. Thus patient-focused and comprehensive pharmaceutical care programs exist according to a hospital's academic program affiliation with Pharm.D. or B.S. degree program.     

Evaluating Community Sex Offender Treatment Programs: A 12-Year Follow-Up of 724 Offenders.

Although some studies suggest positive effects of treatment for sexual offenders, most studies have been hampered by the unknown influence of selective attrition (e.g., volunteers and drop-outs). In the 1980s, the Correctional Service of Canada began to require weekly community treatment sessions for all sex offenders released in the Pacific Region. This policy change provided a unique opportunity for comparing an unselected cohort of treated sex offenders (n = 403) to an untreated cohort (n = 321) released in earlier years. After an average 12-year follow-up period, no differences were observed in the rates of sexual (21.1% vs 21.8%), violent (42.9% vs. 44.5%) or general (any) recidivism (56.6% vs 60.4%) for treated and untreated groups, respectively. The outcome remained comparable after controlling for length of follow- up, year of release, age, and seven static risk factors coded from official criminal history records. Retrospective ratings of the treatment quality also showed no relationship to observed recidivism rates. The static risk factors coded in the current study accounted for considerable variance in recidivism and could easily be used to improve statistical controls in future evaluations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Day hospital/crisis respite care versus inpatient care, Part II: Service utilization and costs

OBJECTIVE: The authors compared service utilization and costs for acutely ill psychiatric patients treated in a day hospital/crisis respite program or in a hospital inpatient program. METHOD: The patients (N = 197) were randomly assigned to one of the two programs and followed for 10 months after discharge. Both programs were provided by a community mental health center (CMHC) in a poor urban community. Data were collected for developing service utilization profiles and estimates of per-unit costs of the inpatient, day hospital, and outpatient services provided by the CMHC. RESULTS: On average, the day hospital/crisis respite program cost less than inpatient hospitalization. The average saving per patient was +7,100, or roughly 20% of the total direct costs. There were no significant differences between programs in service utilization or costs during the follow-up phase. Cost savings accrued in the index episode because per-unit costs were lower for day hospital/crisis respite and the average stay was shorter. Significant differences in cost were found among patient groups with psychosis, affective disorders, and dual diagnoses; psychotic patients had the highest costs in both programs. The two programs had roughly equal direct service staff and capital costs but significantly different operating costs (day hospital/crisis respite operating costs were 51% of inpatient hospital costs). CONCLUSIONS: The programs were equally effective, but day hospital/crisis respite treatment was less expensive for some patients. Potential cost savings are higher for nonpsychotic patients. Cost differences between the programs are driven by the hospital's relatively higher overhead costs. The roughly equal expenditures for direct service staff costs in the two programs may be an important clue for understanding why these programs provided equally effective acute care.